Individual
MRS. MARY F ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9180 PINECROFT DR STE 600, SHENANDOAH, TX 77380-3883
(281) 296-0365
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-0813
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA08197
TX
363AM0700X
Medical Physician Assistant
Primary
PA08197
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
314055003
—
TX
05
—
314055004
—
TX
01
—
8561NJ
BCBS
TX
Enumeration date
01/16/2013
Last updated
01/17/2024
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